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Deemed Eligibility for Infants
Infants receiving benefits under Deemed Eligibility (DE) or Continuous Eligibility will have their eligibility redetermined along with the other household members at the MC RD. If other family members are discontinued from MC due to reported changes or failure to complete the MC RD, the infant remains eligible until he/she turns one year old as long as DE requirements are met. The MC RD due date for the DE child is not until the month of the infant’s first birthday. A redetermination of eligibility for MC must be completed when the infant turns one year old.
The 90-Day Cure Period applies when a DE infant is discontinued for no response to the MC RD at the first birthday. If there is contact within 90 days of the infant’s discontinuance, only the RD information is needed to rescind the infant’s MC eligibility.
If the entire household was discontinued on or before the DE infant’s first birthday the 90-Day Cure Period rules apply to the household’s MC eligibility.
Note: The DE infant’s evaluation may not align with the household’s MC RD due date; as a result, there may be two different 90-Day Cure Periods.
If the infant is determined eligible for a zero SOC program at the annual MC RD, he/she would also be concurrently eligible under CEC until the household’s next RD.
In addition, if the RD shows a decrease in income and the infant has been in a SOC program, reduce the SOC or transfer the infant to a zero SOC program as applicable.
The Periwinkle household has an MC RD due in 5/2016. The Periwinkles failed to respond and were discontinued from MC on 5/31/2016. However, Christoph Periwinkle remained active on MC because he is a DE infant who turns one year old on 10/12/2016.
In this scenario: The 90-Day Cure Period for the household is from 6/2016 through 8/2016. Christoph’s 90-Day Cure Period is from 11/2016 through 1/2017.
The Periwinkle’s provide the RD information in 12/2016, requesting MC for the entire household. The EW rescinds MC eligibility for Christoph, but mails an SSApp for the rest of the household members because the MC RD information was received after the household’s 90-Day Cure Period.
NOTE: The household members will receive eligibility as of the date they complete the intake application requirements. They are also eligible for retroactive MC, if requested.
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